Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Tuesday, January 05, 2010

More on Perversity in the Healthcare IT World: Is Meditech Employing Sockpuppets?

1 a : turned away from what is right or good : corrupt b : improper, incorrect c : contrary to the evidence or the direction of the judge on a point of law 2 a : obstinate in opposing what is right, reasonable, or accepted : wrongheaded b : arising from or indicative of stubbornness or obstinacy3 : marked by peevishness or petulance : cranky4 : marked by perversion : perverted

The common theme in their feedback was how HIT in its present form disrupted private practice physicians, distracted them from the physician-patient relationship and impaired their ability to properly care for patients. See the above-linked post and AAPS survey report.

An anonymous, usually lively and even combative reader "IT Guy," who claims to be an IT professional at an HIT vendor, on occasion leaves comments to my HIT posts.

These are typically in the form of unsubstantiated refutations of the material in the posts, and ad hominem attacks in the unmitigated defense of HIT, e.g., referring to this writer as "a teaching professor at a major university who has virtually no understanding of statistical analysis" oras a "grandstanding self-promoter" (See, for example, here at January 5, 2010 8:53:00 AM EST. Read the entire thread.)

In the latest case, "IT Guy" commented on my report of the AAPS HIT survey responses as follows:

I failed to see the humor in dozens of adverse comments about HIT from private practice physicians, and replied with a link to my initial post about HIT industry perversity mentioned above, which elicited the even more perverse response:

IT Guy said...
No one is dissmissive of legitimate concerns. Luddites are a different story. Most of the "concerns" in that diatribe are of the Luddite variety.

January 4, 2010 1:33:00 PM EST

In other words, a survey of physician concerns is a "diatribe" and it is up to the "IT guys" to determine which physician concerns are "legitimate" and which are of the "Luddite" variety.

"IT Guy" remains anonymous and has been so since he first started posting comments here, despite prodding to reveal his identity to better facilitate an understanding of where his/her viewpoints arose. He/she has neglected to do so.

Even the blogger profile is blank, click to enlarge:

Now, I welcome anonymous comments and have a thick skin - to a point. When the comments go ad hominem or perverse, I do consider deleting them.

However, when such comments are potentially revelatory of major issues, I promoteand amplify them - as now. Read on.

This person also apparently uses the anonymous moniker "Programmer" at the HIStalk blog where he similarly attacks my comments made under my actual name S Silverstein or under MedInformaticsMD. The HIStalk site owner actually edited out defamatory comments made about me in Oct. 2009 at HIStalk comment #28 at this HIStalk comment thread and apologized for this entry on his blog:

#28 Programmer [at HIStalk blog - ed.]October 20th, 2009 at 11:57 am

Yes, it’s that simple. If you select for pre-IT and post-IT data and use a large enough sample size the other factors with equal out. If the sample size is large enough you should have a relatively small margin of error.

[i.e., "Programmer" -- who I soon show is also "IT Guy" -- opines that in comparing clinical adverse event rates pre- and post healthcare IT installation, all you need is a large enough sample size, which then nullifies or cancels out, for example, changes occurring over time that are not related to the intervention, and other potential confounders in a pre-post comparison. If only evaluation studies in healthcare informatics were that simple ... it is concerning that IT vendor personnel might have such beliefs - ed.]And the fact that a teaching professor at a major university has virtually no understanding of statistical analysis makes me say “at least I don’t have to worry about losing my job to one of his students."

[Latter sentence was removed by HIStalk owner - ed.]

Now, back at HC Renewal see this combative comment thread where "IT Guy" a.k.a. "Programmer" refers to that removal, and repeats the above statistical faux pasand ad hominem ("just to make sure I read the whole thing"), and adds another ad hominem for good measure. I let them remain. (Comment dated October 20, 2009 1:35:00 PM EDT.) HIStalk's "Programmer" and HC Renewal's "IT guy" are apparently one and the same.

Getting to the core of this posting, I repeat, when such comments are potentially revelatory of major issues in HIT, I promote them - as here.

Theraison d'êtrefor this postingis an interesting pattern:

Before "IT Guy" posts comments at HC Renewal, "hits" appear from a major health IT vendor's IP in our publicly-accessible Sitemeter log, with outclicks to the comment sections of posts where "IT Guy's" comments then appear.

At the time of the outclick, there were "0 comments" to that post, as shown in the log above. Shortly after, IT Guy's aforementioned "Funny March of the Luddites" comment appeared ... as comment #1.

Likewise today, several "hits" appeared from IP 12.11.157.# with outlinks to the comment thread, for instance as seen below when only 23 comments were present, mostly from "IT Guy", Dr. Poses and myself:

After that, more comments from "IT Guy" appeared starting with ... #24.

The pattern has remained consistent.

Now, the evidence is circumstantial but it does not take a Sherlock Holmes to realize it is quite likely this commenter is an employee of a healthcare IT vendor named in the above links, Medical Information Technology, Inc., a.k.a. Meditech.

I am concerned that a possible employee of an HIT company - any HIT company -- might find physician concerns about HIT as serious as those expressed in the AAPS survey "funny" and "of the Luddite variety." I also am concerned that an employee might think that in situ pre-post evaluations of the technology need not take into account possible confounders.

If this person is an HIT vendor employee and IT professional at this HIT company or any other -- I think it likely he/she holds such a position at some HIT company and such attitudes -- then a number of questions are raised:

How common is this attitude among HIT vendor employees? Is this a systemic problem?

How do such attitudes translate into satisfying customer requests for remediation of HIT defects and problems?

Should HIT vendors be doing better due diligence in their hiring practices to assure they hire IT personnel with a service mentality and who understand that clinicians are the enablers of medicine, they the facilitators? (A point my graduate healthcare informatics students are taught and grasp readily.)

At the very least, perhaps employees of HIT companies (such as the one in the logs above at Meditech, whoever they may be) should pay more attention to improving HIT, rather than spending 1 hour 5 minutes 23 seconds reading 12 posts here during business hours.

"IT Guy" is welcome to continue submitting anonymous comments, but if they contain ad hominem they will be deleted.

-- SS

Addendum 1/5/10:

A HC Renewal reader with an MBA non-anonymously relates the following (emphases mine):

In reading this thread of comments I have to believe IT Guy is a salesperson. My only question is: Were you assigned this blog or did you choose it? We had this problem a number of years ago where a salesperson was assigned a number of blogs with the intent of using up valuable time in trying to discredit the postings.

In my very first sales class we learned to focus on irrelevant points, constantly shift the discussion, and generally try to distract criticism. I would say that HCR is creating heat for IT Guy’s employer and the industry in general.

I find it sad that a company would allow an employee to attack anyone in an open forum. IT Guy needs to check with his superiors to find out if they approve of this use of his time, and I hope he is not using a company computer, unless once again this attack is company sanctioned.

Steve Lucas

I think that is an interesting possibility - someone paid to disrupt. It fits, and again invoking Sherlock Holmes, there is the means, the motive and the opportunity. Time for another definition:

Sock puppeting: "the act of creating a fake online identity to praise, defend or create the illusion of support for one’s self, allies or company." (NY Times)

If true (unfortunately for the salesperson), I make this observation:

To most of the readers of Healthcare Renewal, who find a focus on irrelevancy and irrationality to be signs of foolishness and hysteria (we clinicians have seen it all, by the way), this salesperson has nothing to sell.

Another perversity also comes to mind. If what Mr. Lucas suggests is indeed occurring, a company behind such actions would be exhibiting self destructive behavior in trying to disrupt and discredit those who could actually help them to make better products and be more competitive. I remind that patients are the true "customer."

It also follows that, if this analysis is true, the defamatory attacks left at HIStalk and here at HC Renewal would have been made with foreknowledge of their falsity and with malice. I have informed the company's General Counsel of this information and hope that will be sufficient to cause the harassment from their company to cease.

Defamation, I also add, is certainly not a particularly wise HIT vendor strategy with the HIT industry under investigation by US Senator Grassley (see Oct. 2009 PDF letter to a number of vendors and management consultant firms here).

Having worked in pharma, however, another self-destructive industry due to its internal pathologies, I've seen worse done to critics. Incidentally, another probable blog troll/sockpuppet comment from that industry is in the comments section at this Jan. 2008 post.

6 comments:

Anonymous
said...

HIT vendors, in my experience, simply believe that people who work in hospitals are morons, and are sometimes right. This includes physicians, who despite having years of schooling obviously not having a clue of what to do for patients.

In my years in working for a major AMC in IT, I've been threatened by vendors and have been treated like a moron despite knowing my job and customers simply because I'm trying to help solve a business need, and not buy a useless product.

HIT people should be asking themselves "What can we do to make the job of a caregiver easier and treat our patients better?" on a daily basis. We have "luddite" physicians at our AMC, but it doesn't mean they're stupid. Instead, you have to ask "What can I help with?"

IT shouldn't be antagonistic towards physicians. Our job is to help solve business needs for them and with them (the EMR is a whole 'nother issue.)

I do not suggest or imply that this vendor should be avoided. The evidence is convincing but not 100% - the IP could be spoofed, for example, by a competitor trying to make another company look bad - and even if "IT Guy" is a Meditech employee I do not know if his/her online badgering and harassment was company sanctioned.

Contact Us

Email: info at firmfound dot org
or go to the web-site for FIRM - the Foundation for Integrity and Responsibility in Medicine

More About FIRM and Health Care Renewal

FIRM - the Foundation for Integrity and Responsibility in Medicine is a 501(c)3 that researches problems with leadership and governance in health care that threaten core values, and disseminates our findings to physicians, health care researchers and policy-makers, and the public at large. FIRM advocates representative, transparent, accountable and ethical health care governance, and hopes to empower health care professionals and patients to promote better health care leadership.

FIRM depends on contributions from individuals and non-profit organizations. FIRM does not accept any direct support from for-profit health care corporations.

FIRM welcomes support from individuals and non-profit organizations. If you are interested in donating to FIRM, please email info at firmfound dot org, snail mail us at 16 Cutler St, Suite 104, Warren, RI, 02885, USA, or see our web-site.

Subscribe To Health Care Renewal

Policies: Blog Roll and Comments

Our blogroll is meant to include blogs that provide interesting content relevant to what we write. It is not an endorsement in any way of any specific blog.

We accept comments, especially from registered Blogger users. If you do not wish to register with Blogger, we will accept anonymous comments, although prefer that they contain identification of the commenter.

We encourage thoughtful comments relevant to the issues brought up by the posts on Health Care Renewal.

All comments are moderated. We will reject spam, profanity, advertising of products or services not directly related to the content of this blog.

We will reject any unsubstantiated accusations or allegations.

Nonetheless, all comments represent only the opinions of those making them. The appearance of comments does not imply endorsement by the Health Care Renewal bloggers.

Please email general comments about the blog, other concerns, or questions to info AT firmfound DOT org